Prayingsomeone iswatching outfor Karen

Sunday

Jul 28, 2013 at 3:15 AM

I was on my usual route to work trying to get from my house in Rollinsford to my office at Enterprise Park off Sixth Street in Dover when I saw her.

It was during one of those recent blistering heat waves when it was already 80-plus degrees at 8 o’clock in the morning and there she was pushing her shopping cart as if she were running the Boston Marathon. Her thick, dark hair was flying about wildly and her mouth moved in rapid conversation to no one.

If you live around here, you know who I am talking about. You see her in downtown Somersworth, chugging along with her cart on Route 108, whizzing by Walmart and in pushing through downtown Dover. She must walk at least 35 to 40 miles a day. The locals have a name for her and it is not politically correct or kind. They call her “Crazy _______.” I am using a blank purposely because I do not want to violate her privacy or take away her dignity. I know her first name and so do you, but it isn’t right to use it. In this article, we’ll call her Karen because that is not her real name.

I am not a psychologist or a psychiatrist and I have never seen Karen’s private medical files, but I am pretty sure what the paperwork says — paranoid schizophrenic. She is fearful, always on guard and keeps on the move at all times. She may hear voices in her head, voices she responds to as she appears to talk to no one while walking the streets alone. I have seen her in blistering heat and in the dead of winter trudging in a blizzard. I am not sure how she negotiates the real world of sidewalks, cars, crosswalks, traffic lights and people since Karen is so absorbed in her own world.

Some of my teenage son’s friends talk about “Crazy ______ ,” and I worry. I know they are probably just curious, but still … Would they hurt her? Do they tease her or try to upset her? Do they mock her? I pray they are better than that, but wonder if someone will take advantage of Karen eventually. I know she is not safe, but sadly there is nothing anyone can do about that.

Mentally ill people have the right to be mentally ill, even though they probably don’t have the capacity to make informed decisions about their own care. It seems wrong to me that Karen is allowed to wander the streets muttering to no one and perhaps even putting herself in danger. I’d like to see her in a nice, safe home taking antipsychotic medications every day and learning to communicate with our world. But I have no right to make her do this. Even her family — if they are still around — can’t make her take care of herself.

Karen appears to be in her 30s and wasn’t alive in the horrible days when mentally ill and developmentally disabled people were locked up in institutions that were like giant warehouses. They were hidden away, medicated to the point of stupor and subjected to cruel treatment and filthy conditions. It was a dark time. When I was a college student in the 1970s, the pendulum began to swing the other way. Many powerful people began to fight for the deinstitutionalization of the mentally ill and developmentally disabled. “Titicut Follies,” a 1967 American documentary film about the patients of Bridgewater State Hospital for the criminally insane, was shown on every college campus in America. And, there was a very popular cult movie at the time called “King of Hearts,” starring Alan Bates and Genevieve Bujold. The theme of that film was that mental illness was harmless and a beautiful thing.

Thus began a movement that saw the shuttering of most of the large warehouses where the mentally ill were forced to go. The patients were sent home to live in their communities and accept help (if they wanted it) from local mental health providers. In addition, states, including New Hampshire, passed strict laws preventing the involuntary commitment of mentally ill patients to state hospitals.

Because of this Karen is free to walk the Seacoast, even if her mind is torturing her and she does not have the capacity to fend off the occasional curious or cruel teenager she happens to meet up with. She does not have to take antipsychotic medications or keep her shrink appointments, even if she would be safer doing so.

I called a local expert to ask about Karen. Greg Burdwood, the behavior health transitional coordinator at the New Hampshire Institute for Health Policy and Practice at the University of New Hampshire, has spent his career in the mental health trenches. He did not know anything about Karen and couldn’t disclose it if he did. But he does know the law. In New Hampshire and many other states, an individual has to present a clear and present danger to themselves or others in order to be involuntarily committed to a mental hospital where patients are forced to take treatments, including medication.

“We respect people’s rights to make their own choices unless they will bring bodily harm to themselves, or others,” Burdwood said. To get Karen into a hospital, a petitioner would have to go to court and present reasons why she should be deprived of her liberty. Burdwood, who has been a therapist during his career, said he recalled getting a scolding from a judge after petitioning for the involuntary commitment of one of his patients whom he believed was going to harm himself. The patient had told Burdwood, “I don’t want to live anymore.”

But it wasn’t enough for the judge who wanted to hear that Burdwood’s patient had a definite plan of action to kill himself. If, for instance, the patient said he would jump off the high-rise bridge over the Piscataqua River on the 27th of the month, Burdwood might have convinced the judge to hospitalize the man. But that didn’t happen and, surprisingly, Burdwood isn’t sorry he lost the case.

Burdwood got his start in the mental health field in 1984 at Independence House in Dover. Many of the residents there were in their 20s and 30s and severely mentally ill. “Most of the time,” Burdwood recalls, “they were floridly psychotic,” but, not locked up.

Now, 25 years later, Burdwood runs into some of these Independence House alumni in the community. “They have gone so much farther. Many of them live in their own apartments and have part-time jobs,” Burdwood said — outcomes that would never have happened in the days of institutionalization.

“It’s a very difficult line, but I have to come down on the side of the Libertarians, I guess,” Burdwood said, chuckling softly because it’s a tough call and more than a little uncomfortable at times. Burdwood said he hopes there is sufficient outreach to Karen to present options. If she rejects them, that’s her right.

Though I can see the logic of letting Karen choose and the dangers of taking her freedom away, I still wonder about her every night. I hope she is safe. I hope she is not sleeping outside on a sub-zero winter night. I hope she is not overwhelmed by fear from the unrelenting voices she listens to. And I pray that someone, somewhere in the system, is watching out for her.

Mary Pat Rowland is the Foster’s managing editor and reachable at mprowland@fosters.com.

Never miss a story

Choose the plan that's right for you.
Digital access or digital and print delivery.